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AN 

ON THE 

DISORDERS OF OLD AGE, 

AND ON 

THE MEANS FOR PROLONGING 
HUMAN LIFE. 



BY ANTHONY CARLISLE, F.R.S. F.S.A. F.L.S 

SURGEON EXTRAORDINARY TO HIS ROYAL HIGHNESS THE PRINCE REGENT, 

AND TO HIS ROYAL HIGHNESS THE DUKE OF GLOUCESTER J 

PROFESSOR OF ANATOMY TO THE ROYAL ACADEMY ; 

PROFE8SOR OF SURGERY AND ANATOMY TO THE ROYAL COLLEGE OF 

SURGEONS OF LONDON ; 

AND SURGEON TO THE WESTMINSTER HOSPITAL. 



11 Every stage of human life except the bst, is marked out by certain de- 
Shed limits; Old Age alone has no precise and determinate boundary. " 

Cicero on Old Jge. 




^ PHILADELPHIA: 

PUBLISHED EY EDWARD EARLE, 
Corner of Fourth & Library Streets. 

1819. 




W. M.vrr. Print 



BrunsK 



TO 

THE MASTER, GOVERNORS AND MEMBERS 

OF 

THE COURT OF ASSISTANTS 

IN THE 

ROYAL COLLEGE OF SURGEONS, 

LONDON. 



Respected Colleagues, 

I submit this short exposition of a part of my 
professional sentiments to your competent and equi- 
table judgment. 

My deliberate thoughts are here purposely laid 
open to all men of education, from a hope, that 
such proceeding will tend most effectually to pro- 
mote the Healing Art. 

Surgery must appear more respectable when it is 
known to be established upon rational and scientific 



foundations, and that its rules are deducted from the 
unvarying laws of Nature, and constantly subject 
to the corrections of progressive Experience and 
accumulating Observation. 

Gentlemen, 
Vrour much obliged, 

And faithful Servant, 

ANTHONY CARLISLE. 

S'oho Square, 29th Nov. 1817. 



ON THE 



DISORDERS OF OLD AGE. 



NUMEROUS medical tracts have been written 
upon Longevity, and on the Maladies of advan- 
ced Age ; and it might therefore be unnecessary 
to trouble the public with any further additions, 
were it not apparent, that many of those books 
are too voluminous for common readers, and 
others rendered objectionable by their technical 
perplexities. 

The present Essay is addressed principally 
to persons already advanced in years, and 
does not embrace the course of regimen 
which from an early period is best calculated 
to secure a long life. 



Experience has fully convinced me, that the 

later stages of human life are often abridged 

by unsuitable Diet, or prematurely ended by 

Disorders which are not treated with sufficient 

. wjp..> attention by the Faculty. 

It seems little better than a vulgar error, 
to consider the termination of advanced life 
as the inevitable consequence of time, when 
the immediate cause of death in old persons 
is generally known to be some well-marked 
disease. 

According to my observation, the disor- 
ders of Senility may often be relieved, and 
our declining years extended far beyond the 
ordinary number, by judicious management. 

I need not point out to the wiser and better 
part of mankind, the incalculable value of those 
sages of our race, whose long experience and 
knowledge, so difficult to be communicated, 
may be prematurely lost in the grave ; each day 
that we can prolong their comfortable existence, 



7 

may be of inestimable benefit to their families, 
and the addition of every hour to them may be 
of lasting use to society. 

All impartial observers must have noted in- 
stances of men with contrary habits arriving 
at old age ; and it is both easy and plausible for 
self-indulgence to adduce examples of intempe- 
rate men, who attain to advanced years ; but 
the numbers are not so fairly stated who fall un- 
timely by provoked disease, nor is it inquired 
how little those devotees have comparatively en- 
joyed or performed, in consequence of their dis- 
orderly conduct. 

I trust my brethren will receive this Essay as 
an attempt to increase the respectability of our 
profession, by enlarging its duties, and by offer- 
ing consolation and hope to those who are 
stricken in years. 

These observations necessarily comprise both 
the offices of the Surgeon and the Physician, be- 
cause I could not separate the consideration of 



8 

local distempers from constitutional influences ; 
nor does it seem beneficial to the sick, that 
such distinctions should be practically enforced. 

The infirmities of Age assail different parts of 
the frame ; but some individuals are habitually 
prone to special Disorders. According to the 
laws of our nature, the vicissitudes of every pass- 
ing hour begin to endanger the healthful structure 
of the body as soon as its growth is completed. 
A likeness in the composition of its materials, 
and an exacfsameness of every texture and tis- 
sue, cannot be expected to continue, because 
every part is daily wasting and repairing. The 
error of a subordinate part will, therefore, by 
degrees encroach upon the organs essential to 
health, and the accumulation of such derange- 
ments soon declares us to be mortal. 

In some persons, the vital formations fall 
into early and ruinous disorder, and a premature 
fate ensues, — but it would far exceed my pre- 
sent intentions to exhibit even a general view 



9 

of those causes, which so often destroy mankind 
before they approach Senility. 

After the middle period of life, the creature 
is supposed to have fulfilled the command of 
nature for continuing its race, and the bodily 
fabric then begins to decline. 

The teeth, those implements for grossly di- 
viding the food, are then liable to decay and 
hence the raw material of replenishment is in- 
troduced into the stomach under obvious disad- 
vantages. The compactness and vigour of the 
muscular flesh begin to diminish, and all the 
inward fittings and adjustments are prone to 
give way. 

The eyes and the ears, those out-guards for 
protection, lose their accuteness and sensibility, 
or have their physical accuracy deteriorated, 
and the value of individual life seems to fall. 
At this critical: period, it behoves the tenant to 
keep a strict watch over needful repairs ; and, 
if he have a skilful medical architect, he may 



10 

then obtain useful information respecting the 
best materials for keeping his building together, 
and on the fittest cements and supports to pro- 
tect it against approaching storms. 

The preventive art of Medicine, and the suit- 
ableness of Liet, are well worth considering; 
and, in the autumnal season of life, they will be 
found to comprise the most rational and the 
most practical resources of information. For, 
without fear of contradiction, it may be assert- 
ed, that the wholesome regulation of diet, cloth- 
ing, exercise and air, are often more important 
than the administration of drugs, blisterings, or 
bleedings. 

When the age of maturity has passed, and 
the lungs have escaped a derangement of struc- 
ture, most incident to youth, the common dan- 
gers of life are to be discovered in disorders of 
the head, the stomach, the bowels, the blood 
Vessels, and the liver ; and they display them- 
selves by apoplexy, palsy, indigestion, obstruc- 
tions, inflammations, jaundice, or dropsy. Ma- 



11 

ny of these diseases are happily within the reach 
of medical skill, if attended to in time ; but 
they are severally much more easily avoided, by 
prudent regimen and preventive methods. 

Few persons are attacked by dangerous dis- 
orders without due notice and repeated warn- 
ings: I have never known an instance of apoplexy 
or palsy, until after many previous intimations ; 
nor any serious affections of the stomach, bow- 
els, or liver, without the precedence of some 
morbid visitation, such as head- ache, flatulen- 
cy, acidity, or local pain. It is more than 
probable, that inflammatory diseases occur on- 
ly in vitiated habits ; and when they seem to 
arise spontaneously, or to be occasioned by in- 
adequate causes, they are in truth but roused 
into activity, and owe their remote origin to an 
ill-conditioned state. 

I cannot adopt the irrational opinion of those, 
who attribute all human maladies to a single 
source, or who pretend to remove all distem- 
pers by one remedy. The annals of Medicine 



12 

have been too often disgraced by these and 
similar absurdities, although common sense, lo- 
gic aad science have alike, and at all times, dis- 
carded them. 

Every experienced medical man must have 
felt the harfassing difficulty of discovering the 
real nature and the causes of diseases ; and he 
mi st have equally felt the deep responsibility 
of directing safe and ^efficacious treatment ; nor 
does extended practice clear away those intri- 
cacies. 

It behoves every man who takes upon him- 
self the charge of preserving human life, when 
endangered by the approach of fatal disorder, 
to search well for evidence, to ponder before 
he concludes, and to examine his stores of 
practical knowledge, before he determines to 
employ powerful — perhaps, desperate methods. 

This careful and cautious inquiry charac- 
terizes a good practitioner ; for, upon a quick, 
dear, and, as it were, an intuitive discrimination 



13 

between frivolous and leading facts, a sound 
judgment can alone be formtd, — that solemn 
and deliberate judgment which ought to govern 
the conduct of every medical man, and on which 
the momentous question of Life or Death so 
often depends. 

The age of Sixty may, in general, be fixed 
upon as the commencement of Senility.-*- 
About that period it commonly happens, that 
some signs of bodily infirmity begin to appear, 
and the skilful medical observer may then be 
frequently able to detect the first serious aber- 
rations from health. 

Lo^g continued professional experience has 
taught me to seek for such incipient disorders 
in the evidences of the state of the stomach, 
and in its dependencies, and from the condition 
of the blood and its vessels. Over-fulness of 
the vessels, contamination of the blood, impair- 
ed digestion, and consequent crudities, min- 
gling with the elementary materials of the 
blood, — obstructed bowels, and all the dangers 



14 

which result from impediments to that source 
of keeping the body pure and wholesome, arc 
to be reckoned the leading causes of many dis- 
eases ; — and a scrupulous attention to these 
points, will often discover the beginning of bad 
health. 

A dislike to blood-letting, founded on erro- 
neous opinions, is very prevalent in old per- 
sons, and even many Physicians sanction the 
prtj udice. 

I do not aver that plethora is an invariable 
condition of old age ; but, whenever it does oc- 
cur, it constitutes a dangerous feature. 

The state of the pulse, and other signs of an 
excessive volume of blood, would often mark 
out the expediency of bleeding, if a prejudice 
about its weakening effects did not obtrude ; 
but I am convinced, that the feebleness of age, 
when produced by sanguineous oppression, can 
only be removed by diminishing the quantity of 



15 

blood, and that, on the promptitude of such 
measure, the safety of the patient will depend. 

The fibres in old persons are relaxed, and 
the flexible solids, together with the blood ves- 
sels, are mere yielding than they are at a more 
vigorous period. From the same cause, that 
muscular engine, the Heart, labours under a 
diminished power, while it is obliged to drive 
on the circulation, under the disadvantages of 
weakened and distended vessels. 

The separating of fluids from the blood, call- 
ed the secretions and excretions, is also lessen- 
ed or deteriorated, so that the ordinary methods 
of its purification, and of balancing its quantity, 
become impaired ; hence, in extreme old age, 
the blood is liable to be disproportionedj or to 
be vitiated, in its composition. 

The heart and the blood vessels are subject, 
however, to disturbances, independently of any 
improper quantity of blood, or any discoverable 
change in its qualities. Of this kind are some 



16 

disorders of the stomach, which occasion sud- 
den and violent rushings of blood into the head, 
and which seem to be the immediate conse- 
quence of deleterious food. This example be- 
ing one from a long list of similar maladies* 
shows how inadequate the mere mechanical ex- 
planations of anatomy are, in the practical ser- 
vice of medicine. 

As to the allejged peculiarities and deviations 
from the ordinary course of the human consti- 
tution, which have been called Idiosyncracies, 
I profess myself doubtful ; and I apprehend, 
that a deeper scrutiny will assign those appa- 
rent incongruities to the variable degrees of 
power in the living organs. Fortunately for 
the value of medical precedents, and for the 
utilitjP of our experience, those alleged discre- 
pancies are very rare, otherwise the records and 
testimony of our faculty would be of little val- 
ue. It must, however, be confessed, that the 
usefulness of written knowledge is mostly con- 
fined to those who are prepared by experience to 
discern its correctness, and to measure its appli- 



17 

cations. Verbal representations are necessarily 
very general ; and the things treated of by lan- 
guage alone, must be the most intelligible to 
those who are already practically acquainted 
with them. 

Of all the preventive and curative remedies 
whose effects I have carefully witnessed, the 
most beneficial are Cathartics and Blood-let- 
ting ; but those powerful means are only effica- 
cious when skilfully directed. 

It is a gross and dangerous presumption for 
unprofessional persons to prescribe for the sick, 
because few disorders wholly depend on single 
errors of the body ; and when the co-operation 
of several means are called for, such as both ca- 
thartics and bleeding, their salutary effects may 
turn upon the precedency of the one to the 
other, on the selection or doses of the drugs, or 
on the quantity and mode of bleeding. 

In addition to those exertions of an experi- 
enced judgment, it is the indispensable duty 



18 

of a medical practitioner to order the Diet, and 
to adapt the special articles of food and drink to 
every vicissitude of health. 

When it is considered that many serious dis- 
orders are entirely occasioned by improper diet, 
and that in almost every disease, the direction 
of diet is perhaps of equal importance with the 
prescription of medicines, it is blameable to 
neglect this potent resource, and to rely on the 
unaided administration from the Apothecary's 
stores of a few grains of materials, whose quali- 
ties are ill understood. 

Numbers of learned and honourable men are 
engaged in the Medical Profession, and the rank 
which they deservedly hold in society, places 
them above the suspicion of any unworthy love 
of mystery. Those long continued technical 
obscurities, which at one time constituted the 
very form and body of the profession, seem to 
be now yielding to the fairer pretensions of sci- 
ence and intelligible observation. 



19 

When the concealments of the medical art are 
laid aside, and the candid avowal of plain sense 
and of natural knowledge is substituted for oc- 
cult proceedings, the Faculty will be more 
faithfully respected, and the customary fees as 
freely given for advice about regimen, as ever 
they have been for an elaborate prescription. 

- 

The propagation of what is termed general 
knowledge, threatens a speedy invasion of those 
privileged establishments which uphold medi- 
cal mystery ; and a prevailing suspicion attri- 
butes to all such concealments, the disgrace of 
mercenary motives, or the equally base design 
of covering presumptuous ignorance. 

In making this exposition, I entertain a gen- 
uine desire that my Professional brethren and 
scholars, m general, should see distinctly that 
its sole object is to advance the claims of well- 
qualified practitioners to the respect and confi- 
dence of a class of persons, who ought ever to 
influence the opinions and actions of the mass 
of society. 



20 

Many valuable works, exhibiting the pre- 
sent state of medical knowledge, have been 
lately published ; but as none of them corres- 
pond exactly with the results of my experi- 
ence, I feel it a becoming duty to present my 
own doctrines in this public manner. 

The particular restrictions on Diet, which I 
have found to be so useful to the Aged, are 
equally applicable to delicate and sickly persons, 
to young children, and to breeding and nursing 
women : and the divulging of these observa- 
tions may possibly awaken medical practition- 
ers to the important subject of general regi- 
men. The difficulties, uncertainties, and perils 
of our art, are sufficiently known, to justify eve- 
ry fair attempt to improve the knowledge of the 
causes of bad health, and to expand our means 
for alleviating or curing disorders. 

■ 
This brief contribution of general sugges- 
tions, respecting the medical treatment of old 
persons, is but a specimen and small fragment 
of my professional collections ; it is, however. 



21 

sanctioned by experience, and composed under 
some peculiar advantages, at a mature age. 

The most numerous tribe of disorders inci- 
dent to advanced life, spring from the failure or 
errors of the stomach and its dependancies, (as 
already observed) ; and perhaps the first source 
of all the infirmities of senility, may be traced 
to effects arising from imperfectly digested food; 
nor does it seem probable, that any effectual 
means will ever be discovered to counteract this 
progressive and inevitable failure of our nature. 

It is obvious, as the organs for digestion lose 
their vigour, the food should be adapted to the 
degree of decline which invades the stomach and 
its subordinate parts ; and the state of the bile, 
and the discharges from the bowels, should be 
then attentively watched, and duly regulated by 
diet and medicines. 

It is logically evident, that if the same kind 
of nutritious materials were constantly produced 
in the human frame for its repairs and uses, the 



22 

same compounds and textures would continue 
unaltered by time, and the vigour of youth and 
health would be steadily maintained. It is 
therefore clearly obvious, that every defect in 
the composition of our bodily materials must al- 
ter its condition. 

From the steady causes which govern the ac- 
cretion of figured minerals, they increase in 
bulk with perfect regularity, and are exempt 
from the limitations of age or growth ; but the 
organized structures of living animals and vege- 
tables are differently constituted. 

The materials for the residence of life, being 
formed of unstable substances, are continually 
decaying, and giving place to new supplies de- 
rived from assimilated fluids, which are elabo- 
rated by the vital offices. By this system of 
borrowing and expenditure, a certain degree of 
renovation attends the maintenance of animal 
and vegetable bodies, which is w r isely adapted 
to their liability to accidents, and to the ordina T 
tions of a limited existence. 



23 

In every stage of human life, the functions of 
the Stomach are of principal importance to 
health ; and the same rules for diet, which 
prove beneficial to the aged, will generally ap- 
ply to all invalids, unless where the exceptions, 
hereafter to be mentioned, forbid an exact re- 
gimen. 

Whatever objections may be urged against 
young persons living by rule, they certainly do 
not apply to old age ; neither do I admit of 
much latitude for peculiarities of constitution, 
especially if they tend to license habits which 
are known to be injurious. 

The substances selected for the diet of old 
persons, and the cookery of their food, should 
be adapted to the state of their teeth ; and solid 
viands, or those kinds which are difficult of so- 
lution, should be minced, bruised, or otherwise 
prepared to meet the defects of the chewing in- 
struments. 



24 

In addition to the gradual failure of the teeth, 
the stomach itself suffers a diminution of its 
powers to convert food into the raw fluid mate- 
rial for bodily replenishment ; and hence it be- 
comes needful to be more choice and particular 
about the diet in advanced years. 

In old age the bowels are also liable to an in- 
creasing torpor, which demands that a prefer- 
ence should be given to meats not remarkably 
putrescible. 

On a general view of the most suitable Diet 
for the aged and the feeble, it may confidently 
be asserted that animal substances are more ea- 
sily changed into nutritious fluids by digestion, 
than vegetables ; and it is reasonable to infer, 
that the digested substance of animals is more 
readily converted into the medium of replenish- 
ment, than that of vegetables ; still, however, 
there are many exceptions to this rule, since the 
soluble muscilages, farina, and pulps cf some 
vegetables, are known to be more digestible, 



25 

than the tough and hard parts of animals, which 
are difficult both of solution and digestion. 

In like manner the several parts of meat, as 
the skin, tendon, muscle, and fatty membranes, 
differ from each other ; and they are severally 
capable of being made more or less digestible 
by the culinary art. The statement of special 
examples will, however, best illustrate this 
subject. 

It is a vulgar error to esteem white meats, on 
account of their apparent delicacy, as the fittest 
for feeble persons. Generally, it may be es- 
teemed a safe rule, that veal, pork, fowl, and tur- 
key, are less digestible, and afford less nourish- 
ment, than the redder- fleshed animals. 

The intrinsic goodness of meats is always to 
be suspected, when they require spicy season* 
ings to make up for their natural want of sapidity. 

In the course of practice, I have constantly 
found Veal to disagree with weak stomachs; 

4r 



26 

the sugar of milk which it contains, disposes it 
to pass into the acetous fermentation ; and be- 
sides, it possesses an excess of tough fibre, des- 
tined to complete the bulk of the mature ani- 
mal, and which is a substance of difficult solu- 
tion. The pot-herbs and other seasoning em- 
ployed for savoury stuffing, add to its unsuita- 
bleness. 

Pork is also an unfit meat for the feeble, the 
excess of its fat rendering it liable to ferment ; 
the physical properties of Fat are also different 
from those of fluid nutriment, of which Milk 
and Blood may be considered the standards of 
comparison. 

Turkey, and the older domestic Fowls, are 
equally objectionable. 

Salted meats, as ham, tongue, bacon> and 
salted beef and pork are to be forbidden, be- 
cause the preserving material hardens the ani- 
mal fibres, alters the juices of the meats, and 
impregnates them wiih an excess of salt, be- 



27 

yond what is convenient for the operations of 
the stomach. 

The particular parts of meat which are im- 
proper for the aged, are the gristles, browned 
surfaces from over-roasting, tendons, and hard 
fat. 

Unless the processes of Cookery render the 
parts of meat quite soft and soluble, they often 
make them more difficult of digestion. Thus 
overdone meats, and outside portions, as the 
crusty and torrified surfaces, are less proper 
than the more juicy and underdone flesh. 

I am also of opinion that boiled meats are for 
the most part less digestible and contain less 
nutriment, than the same meats when roasted or 
broiled. 

Fish may be considered as ineligible for the 
aged, because of its aptitude to putrefaction, 
and because of the deleterious products of that 
fermentation when it happens in the bowels or 



28 

stomach. The relative degrees of their unwhole- 
someness may be, perhaps, fairly estimated in 
the following order : — The most pernicious are 
shell-fish, since they are often notoriously the 
cause of surfeits, erysipelas, Sec. more especial- 
ly when tainted ; and herrings, mackarel, sal- 
mon, and eels, seem to be next in the range of 
indigestible fish. The best sorts are whiting, 
perch, flounders, smelts, skate, haddock, tur- 
bot, and soals. It may be remarked, that boil- 
ed fish more frequently proves agreeable to the 
stomach than fried. The same objections may 
be adduced against salted fish, as were before 
alleged against salted meats. 

An excessive and cheap supply of Fish to the 
inhabitants of large cities, is a very questiona- 
ble policy ; but, in times of putrescent conta- 
gion, it seems especially dangerous. 

Milk is the food destined by nature for the 
infant period, and it seldom proves agreeable to 
old persons ; the sparing use of cheese and but- 



29 

ter should also rather be permitted than recom- 
mended. 

Of the Vegetable kind, those which are un- 
cooked, such as cucumbers, onions, celery, 
radish, salads, water-cresses, and likewise 
pickles, will be found injurious. Even the 
hard pulped fruits, such as apples, nectarines, 
peaches, seme kinds of pears, plums, and cher- 
ries, are apt to pass through the body undigest- 
ed, to ferment, and produce a train of evil con- 
sequences. 

Great choice and nicety are required in adapt- 
ing the kinds and quantities of fruits to the 
healthful diet of the aged. The sweeter refresh- 
ing juices of strawberries, raspberries, grapes, 
oranges, and currants, may be occasionally salu- 
tary ; but either excess, want of selection, or 
the indiscriminate indulgence in them is nox- 
ious. Dried fruits, such as raisins, figs, prunes, 
&c. are more indigestible, than when fresh ; 
and, I believe, it is incorrect to ascribe to them, 
generally opening properties. The nut and 



so 

almond tribe should be excluded from the ta- 
bles of the aged ; and, perhaps, the whole cata- 
logue of dessert refreshments, and sugared con- 
fectionary, should be forbidden, with the excep- 
tion of the fruits already enumerated. 

When Fermented Liquors are good for the 
feeble, those which are well fermented, and 
which have little sugar or free acid should be 
preferred. The Rhine and French wines are 
objectionable, as well as luscious sweet wines, 
and Malt liquors, because they either contain a 
free acid, or readily pass into the acid state in the 
stomach. Long continued and watchful obser- 
vation induce me to conclude, that the acid qual- 
ities of fermented liquors are. no less injurious 
than the spirit which they contain. The acid pro- 
perties appear, however, to be less hurtful to 
youth, than the spirituous ; while the reverse 
obtains with aged persons. 

As the determination of the relative quantities 
of F'-ee A- id in ordinary fermented liquors 
seemed to be important, I requested my accu- 



31 

rate pupil, Mr. Hare, to make a series of 
chymical experiments for that purpose, under 
my own superintendence, the gross results of 
which appear in the following, table :■ 



32 

TABLE of the Medicinal Alkalis and Earths 
required to neutralize the Free Acids contain- 
ed in certain Wines and Malt Liquors. 



Port Wine. 

A moderate sized 
glassful, contain- 
ing two ounces 
avoirdupoise wt. 


NEUTRALIZED BY 

Henry's calcined Magnesia 
Carbonate of Potash 
Snb-carbonate of Soda 
Prepared Chalk 
Liquid Potash 
Liquid Ammonia 


.2 
"8 


Drops, 
by fluid 
measure 


3^ 
6* 
4 
9 


11 

13 


Vidonia. 

Two ounces, as 
above stated. 


Henry's calcined Magnesir. 
Carbonate of Potash 
Sub-Carbonate of Soda - 
Prepared Chalk 
Liquid Potash 
Liquid Ammonia - 


5 
7 
6 

12 


32 
19 


Sherry. 

Two ounces, as 
above stated. 


Henry's calcined Magnesia 
Carbonate of Potash 
Sub- carbonate of Soda - 
Prepared Chalk 
Liquid Potash 
Liquid Amu onia - s - 


3 
5 

8 


9 
11 


London Draught 

Porter. 
Two ounces, by 
weight as above. 


Henry's calcinei Magnesia 
Carbonate of Potash 
Sub-carbonate of Soda - 
Prepared Chalk 
Liquid Potash 
Liquid Ammonia - 


5 

3i 

3 

6 

2 
2 
5 


6 
10 


JHem y's calcined Vlagne^ia 
Brewers' fresh Ta- jCarbonate of Potash 

ble Beer. Sub-carbonate of Soda - 
Two ounces, by Prepared Chalk 
weight as above. Liquid Po' ash 

'Liquid Ammonia - 


4 
6 



S3 

The Alkalis and Earths used in Medicine, as 
correctives for acidity in the stomach, and ob- 
tained from Apothecaries' Hall, were preferred 
for obvious reasons. 

Specimens of several kinds of good Wines 
from Gentlemen's cellars were employed, with- 
out any regard to the years of vintage or the 
dates of bottling, and the average of numerous 
trials upon Wines of different qualities are faith- 
fully recorded. 

- Due time was always allowed for the operation 
of the tests, and much pains bestowed upon as- 
certaining the exact state of neutralization. 

The facts elicited from those trials, being 
wholly intended for medicinal and dietetic appli- 
cation, all particular minutiae are intentionallv 
omitted. 

Some remarkable and unexpected discordan- 
ces occurred in the relative proportions of Alka- 
lis and Earths, required to neutralize different 

S 



34 

wines, and which may be owing* to the varying 
affinities of native acids, derived from the fruits, 
and the acid products of fermentation, as they 
regarded the several tests. 

The peculiar acids of Fermented Liquors be- 
ing at present but imperfectly known to Chy mists, 
some practical good may arise from this gross 
display of acid liquors, both in the adaptation of 
the medicinal doses of anti-acids, and in the 
choice of wines where disordered acidity of the 
stomach prevails. 

The annexed table exhibits gross proofs of 
the quantity of Free Acid contained in some or- 
dinary fruits, and which may serve as a dietetic 
indication ; exclusive of the additional acid pro- 
duced by fermentation in the stomach : 



35 

TABLE of the Medicinal Alkalis and Earths 
required to neutralize the Acid Juices con- 
tained in Lemons, Oranges, and certain Ap- 
ples. » 



For a common 
sized Lemon. 


NEUTRALIZED BY 

Henry's calcined Magnesia 
Carbonate of Potash 
Sub-carbonate of Soda 
Prepared Chalk 
Liquid Potash 
Liquid Ammonia - 


DD 

.2 
*3 

c 


Drops, 

by 
measure 


30 
38 
34 
52 


80 
92 


A common sized 
Sweet Orange. 


■-7 

Henry's calcined Magnesia 
Carbonate of Potash 
Sub-Carbonate of Soda - 
Prepared Chalk 
Liquid Potash 
Liquid Ammonia - 


12 
9 
6 

16 


15 

18 


An ordinary sized 
Nonpariel Apple. 


Henry's calcined Magnesia 
Carbonate of Potash 
Sub-carbonate of Soda - 
Prepared Chalk 
Liquid Potash 
Liquid Ammonia - 


7 

6 

5 

15 


14 
16 



The sum of these tabulated experiments may be practical- 
ly reduced to the following conclusions. An average bottle 
of ordinary Port wine contains as much acid as will demand 
38£ grains of magnesia, or 71$ grains of carbonate of potash, 
to saturate it : or the free acid in a bottle of Port wine may 
be roughly computed as equal to that of two lemons, or four 
nonpariel apples. 



36 

A habit of drinking any diluent-liquors very 
freely appears to be pernicious ; such fluids not 
only relax the stomach, but also present the best 
medium fo» fermentations of the most unwhole- 
some kind. 

Every medical man ought to possess more 
accurate knowledge of the disorders which have 
occurred in his own person, than of those which 
belong to others ; and I am satisfied, from that 
source of experience, that acids not only act 
upon the stomach and its contents, but they 
likewise pervade the whole bcdy. I have con- 
stantly had an eruption of serous pimples on the 
skin within two hours after eating crude fruits, 
and have repeatedly felt a goury pain and swell- 
ing in the large joint of the great toe, while 
drinking half a point of Claret ; and similar facts 
have been mentioned to me by numerous Pa- 
tients. 

If the Gout should be a humoral disease, oc- 
casioned by alimentary acids, then the Diet and 
the corrective remedies are obvious, and expert 



37 

cnce seems to support this notion. That the 
gout is not a disease wholly attributable to fer- 
mi lied liquors is certain, because many water 
drinkers, and restrictive vegetable eaters, are sub- 
ject to its attacks ; but, perhaps, the true 
source of gout in such temper? te persons may 
be found in the crude and fermentable articles of 
their Diet. It is both an act of justice to the 
public and myself to add, that my practice, 
whenever it has come in contact with gouty per- 
sons, has been governed by the preceding views, 
and attended with unvarying beneficial results. 

The dark red fleshed meats are the fittest arti- 
cles of Diet for feeble and invalid stomachs ; 
such as venison, game, mutton, and beef, which 
should be chosen of the tenderest kinds and ju- 
diciously cooked. 

The duck and goose tribe have wholesome 
flesh, but the fatness of their skins, and the usu- 
al mode of seasoning, render them objectiona- 
ble. 



38 

The good old custom of dining in the middle 
of the day will be found conducive to health and 
sleep ; it is best adapted to the decline of animal 
vigour, because it affords a timely replenish- 
ment, before the evening waning of the vital 
powers, and which naturally precedes the hour 
of rest. 

Bland and simple soups made of game, beef, 
mutton, or giblets, are often suitable, but veal 
and indissoluble vegetables should be excluded. 

Some preparations with milk, and arrow- root, 
flour, bread, biscuit, macaroni, or ground rice, 
may afford an eligible diversity ; but the custom 
of eating much fermented bread, or of break- 
fasting on spongy rolls, muffins, &c. is improper, 
as they are less digestible than softened biscuit, 
and contain an excess of yest sufficient to pro- 
mote fermentation. 

That elegant, fragrant, and refreshing beve- 
rage, Tea, the hourly refection of the largest 
and, perhaps, most civilized nation in the world, 



39 

need not be denied to the aged. It is well suit- 
ed to cleanse and wash the stomach in the mor- 
ning, preparatory to the substantial meal ; and 
when taken in moderation, it is a delicious di- 
luent immediately after that repast. 

If the Dinner be eaten at mid-day, the equivo- 
cal entertainment, called Luncheon, is superflu- 
ous. 

The purity of Water for drinking is so essen- 
tial, that it may be questioned whether any 
healthful residence can be found, where the con- 
trary is notorious. Toast- water is best made 
with hard biscuit, reduced by fire to a coffee 
colour. This drink being free from yest, is a 
most agreeable beverage. 

Long established use may render Coffee inof- 
fensive, but it is more apt to become sour than 
either Tea or weak Chocolate, and it seems to be 
more heating. 



40 

The vegetable additions to dinner ought to be 
of the softer or farianaceous kinds, such as 
green pease, asparagus, cauliflower, beans, mea- 
ly potatoes, and rice, or simply dressed macaro- 
ni. Cabbage and brocoli are coarse and offen- 
sive, unless when boiled in two successive wa- 
ters and rendered bland. This process of twice 
boiling frees the cabbage-tribe from noxious 
matter, which occasions flatulencies and other 
unhealthy effects. j 

Carrots are better reduced to a pulp, and Tur- 
nips should be free from woody fibres. Spinach 
should be treated in the French manner, by 
pressing its pulp through a hair sieve, and with 
the addition of spicy seasoning. Onions, and 
roots of that sort, contain accrimonious juices, 
and are in no way nutritious. • 

Several changes may be obtained by stewing 
Celery, Cucumbers, and other dissoluble veget- 
ables ; but it may be safely adopted as a rule, 
that whatever food produces flatulency, is un- 
suitable. 



41 

With all kinds of vegetables, as also with 
soups, and fish, either black or Cayenne pep. 
per may be taken freely : they are the most 
useful stimulants to old stomachs, and often 
supersede the craving for strong drinks, or di- 
minish the quantity otherwise required. 

A little Ginger in the Tea is also stimulating, 
and grateful -to the palate. 

No apology can be expected for discussing 
subjects connected with Cookery, and the do- 
mestic ordering of Diet, which in my estima- 
tion are highly important matters ; ' and a close 
attention to them has often proved satisfactory, 
when the Materia Medica has failed. 

The great Father of the Medical and Chirur- 
gical Art, Hippocrates, laid much stress up- 
on diet, and a whole sect of later Physicians pro- 
fessed to reiieve disorders by Diet alone* 

Although regularity in Diet and strict Tem- 
perance, both as to the quantities and qualities 

6 



42 

of viands and drink, are of the highest conse- 
quence for the health of the aged, yet a long 
continued and exact sameness in strict habits is 
not always beneficial. Little deviations from 
one kind of proper Diet to another, still keep- 
ing within the bounds of moderation, are con- 
sonani with the system of Nature, and are ap. 
proved by experience. Perhaps the changes of 
the Seasons and the consequent variety of ali- 
ment thereby presented to the animal creation, 
may be needful and wise ordinations to induce 
alterations of Diet, and of the external influen- 
ces from the Air ; both of them having the effect 
of interrupting the continuance of constitution- 
al errors. Thus by a general, simple, and un- 
observed governing power, the bodies of the 
Animal creation are beneficially adapted to the 
revolution of the Seasons, and the harmony of 
the vegetable and animal kingdoms is beauti- 
fully preserved. 

It may be doubted, whether the artificial re- 
sistance to the seasons which Affluence com- 
mands, is on the whole beneficial to the families 



43 

of its possessors, in consequence of their fre- 
quent misapplications ; and I am, therefore, 
obliged to consider this operation of wealth, as 
a great source of both heredetary disease and of 
enfeebled progeny, 

A long continued sameness of local and of 
family habits, does not act in the same degree up- 
on labouring persons ; but, in all cases of locally 
protracted generations, the consequences are, 
the augmentation or establishment of some con- 
stitutional and heredetary disorder. 

It seems probable that many diseases are more 
immediately propagated by the influences of lo- 
cal and dietetic habits, than by taint of blood, 
or by corporeal and organic similitudes ; and 
this view extends equaily to Scrophula, Gout* 
and Insanity. 

Where, however, Riches are wisely employ- 
ed, the effects of unhealthful local causes may 
be interrupted by change of residence, adapted 
to the peculair disordered tendency, and to the 



44 

unsuitableness of particular seasons. For as 
the animal energies are never stationary, perhaps 
health may in all cases be promoted by occa- 
sional vicissitudes. It might be wished that 
Art could secure an equable state of health, but 
the laws of animal life seem to forbid it, and the 
following notorious facts support a contrary de- 
cision. 

In the training of athletic men, of race horses, 
and fighting cocks, experience has shewn tint 
their strength cannot be preserved in its highest 
vigour for many weeks together, and every at- 
tempt to force its continuance is followed by dis- 
orders. Temperance may be carried so far as 
at length to border on abstinence, or it may be 
altogether erroneous and directed to wrong ob- 
jects. Excessive abstemiousness is seldom 
conducive to health, because a copious supply 
of fresh and wholesome material seems to be 
peculiarly needful for the aged, whose bodily 
offices are becoming every day less perfect : 
frequent and abundant supplies of renovating 
j uices are more requisite in a vitiated condition 



45 

of the fluids, and where the maintenance of a 
due quantity of blood is precarious, both of 
which occur when the vital operations are en- 
feebled. The obstinate fasting of maniacs of- 
ten occasions a disease which resembles the 
sea-scurvy. The errors of temperance depend- 
ing on an unsuitable chcice oi food and drink, 
as they regard different constitutions and the 
younger stages of life, form an expansive sub- 
ject far beyond the intended limits of this Trea- 
tise ; it may, however, prove expedient at pre- 
sent to remark, that a weak stomach is wholly 
incapable of digesting many substances, which 
are commonly esteemed simple and inoffensive. 

For example, persons liable to Heart- burn, or 
St. Anthony's fire, may think it right to re- 
strict their diet to fruits, raw vegetables, shell- 
fish, and lemonade, although each of them are 
adequate causes for such habitual disorders. In 
like manner, the victims to Gout may assume 
great merit to themselves by abstaining from 
animal food, and by living upon a simple aces- 
cent diet, most pernicious to their constitutions. 



46 

Diet, judiciously ordered, equally promotes 
bodily and moral health ; for good digestion fa- 
vours refreshing sleep, and causes a state of 
corporeal hilarity conducive to moral enjoy- 
ments; while, on the contrary, a disordered 
state of the stomach and its dependancies cre- 
ates troubled dreams and irritations of the tem- 
per. May not some kinds of mania be attribu- 
table to continued disturbances of the stomach 
and bowels, and which in time deprive the op- 
pressed sufferer of the power to distinguish be- 
tween his sleeping and waking impressions ? 

Cold baths, and what is called " bracing air," 
do not appear to produce much tonic effect up- 
on old persons ; and, besides, any sudden chill- 
ing of the skin repels the capillary circulation 
throughout the surface of the body, and drives 
the blood upon the inward parts, which is al- 
ways attended with danger to persons advanced 
in life. 

Tepid baths may be recommended, as no 
less pleasant than salutary ; for ablutions of war 



47 

ter have a constricting influence upon the living 
fibres, independent of temperature, an effect per- 
haps similar to that of crimping fibh. 

Warm clothing is proper for the aged, and 
the maintenance of a temperate atmosphere in 
lofty and well ventilated rooms. Where a 
choice of climate can be made, a preference 
should be given to that which possesses a dry 
warm air, and where the vicissitudes of the sea- 
sons are moderate. 

Exercise should never be imposed as a task, 
nor continued until it produce fatigue ; but 
should be moderate and suited to the inclina- 
tion of the party, otherwise it becomes labour. 

The tranquil sorts of indulgence are to be 
preferred ; and it is pleasing to reflect, that most 
of the essential accommodations for Old Age 
are nearly as attainable by persons in moderate 
circumstances as by the affluent. 



48 

Those simple and wholesome requisites for 
advanced life are not expensive ; since when 
the vanities and turbulent propensities of youth 
have subsided, and the bad passions of envy 
and ambi ion have passed away, it is the con- 
dition of our nature to be more easily satisfied. 

The medical administrations for old persons 
which experience warrants me to commend, 
are few, and, I trust, rationally supported. In 
addition to special Diet, they consist of cathar- 
tics, bleeding, acids, alkalis, mercurials, and 
chalybeates. 

The health of the body cannot be maintained, 
unless the bowels perform their natural offices 
regularly and sufficiently, and when this whole- 
some evacuation is impeded, it must be forced 
by art. 

There are various causes of obstruction of 
the alimentary passages ; they may be rendered 
torpid by oppression of the brain, or sluggish 
by the advancing insensibility of age ; or the 



49 

muscular powers of the stomach and the intes- 
tines may be exhausted upon crude and indi- 
gestible food, so as to disable them from duly 
protruding their feculent contents. The Bile, 
that natural cathartic stimulant, may be defi- 
cient, or obstructed ; it may not possess its re- 
quisite qualities, or its effects may be counter- 
acted by improper Diet. 

The class of cathartic medicines comprises a 
numerous list, and each differs in its mode of 
operation, either as it affects the stomach, or the 
upper or the lower intestines ; some act by in- 
creasing the muscular contractions, some by 
causing an increased flow of watery juices into 
the bowels, and others by stimulating the bil- 
iary vessels to pour out their cathartic fluids. 

Although each of such medicines may be fit 
remedies for particular disorders, yet the suc- 
cess of their employment will depend on the 
adaptation of the drugs to the nature of the mal- 
ady, the amount of their doses, and the times of 
their administration. In exhausted states of the 

7 



50 

body, dry and hard pills are slow of solution, 
and they are apt to create head-ache and great 
distress, until their concentrated materials dis- 
solve and become diffused over the interior of 
the stomach. I have found such pills undis- 
solved in the stomach on the third day after 
they had been taken ; but my professional 
thoughts upon Cathartics are before the Public 
in a copious tract, printed in The London 
Medical Repository, for the year 1814, 
Vol. 1. 

The leading indications which guide the skil- 
ful and discriminating practitioner in directing 
cathartics, are to be observed on the tongue, 
which shows the condition of the stomach and 
bowels ; in the colour of the urine and iaeces ; 
and on the appearance of the skin ; by which 
tokens, the state of the biliary system may be 
discovered. 

These evidences are, however, liable to be 
blended with disordered states of the sanguifer- 
ous vessels, and on the detection of such errors 



51 

the question of blood-letting depends. The 
signs of over-fulness or scantiness of blood are 
commonly well marked. A strong beating, 
large pulse, with high temperature of the body 
and limbs, deep-coloured lips, and tense, swol- 
len veins, express the state called plethora, or 
excess of blood. 

When those symptoms are accompanied by 
frequent obscurations of sight, swimming in 
the head, giddiness, intense head-ache, drowsi- 
ness, laborious breathing, or feelings of terror, 
blood-letting should be confidently directed 
without any reference to the age of the patient. 
Many fatal diseases of the head or lungs in 
very old persons originate from plethora or lo- 
cal congestion, and free bleedings with the lan- 
cet, by cupping, or leeches, are the only effec- 
tive remedies. How many persons in the most 
advanced stage of life are respited from the 
grave, by spontaneous bleedings from the nose, 
or from piles ? 



52 

It is true, that mere anatomical or mechani- 
cal practitioners, are unable to appreciate the 
peculiar advantages of topical blood-letting, but 
the more scientific part of my brethren, who 
have considered the hydraulic discoveries of 
Venturi, and the experiments of Spalan- 
zani on the circulating fluids of animals, will 
perceive the practical bearings of those disco- 
veries. 

Intermissions of the pulse in old persons af- 
ford no justifiable objection to blood-letting; 
but, on the contrary, that irregularity rather 
seems to depend on oppression of the heart from 
surcharges of blood beyond the rate of its en- 
feebled muscular powers, and the pulse gene- 
rally becomes more equable after the excessive 
volume of blood is reduced. Neither does a 
sudden oedema supervening on true inflamma- 
tory diseases furbid blood letting, because se- 
rous effusions are frequently the known effects 
of such diseases. I have seen persons above 
the age of seventy, labouring under dangerous 
Inflammation of the lungs, with a sudden acces- 



53 

sion of dropsical swelling in the legs, and who 
were acknowledged to be saved from the jaws 
of death by resolute and copious bleedings in 
contempt of the oedema, 

The judicious direction ofB'ood letting forms 
a£n essential part of medical skill, but unfortu- 
nately the judgment which is to guide the 
practitioner, is unattainable except it be derived 
from experience. 

A small, weak beating pulse, pale lips, a low 
temperature of the body, cold hands and, feet, 
and a remarkable aptitude to become chilled in 
cold weather, are the signs of paucity of the 
blood and feebleness of the circulation. The 
complexion of the face is not a criterion of the 
quantity of the blood, for I have often known 
the true sanguineous apoplexy to attack persons 
with remarkably pale countenances. That dis- 
ordered condition which is produced by scanti- 
ness or poverty of the blood, must be remedied 
by plentiful and nutritious diet, suited with re- 
spect to quantity, quality, and times of refresh- 



54 

merit to the digestive capacities of the individu- 
al. Wines, if agreeable to the constitution and 
habits of the weakened invalid, are often benefi- 
cial. They seem, when congenial, to invigo- 
rate the heart, to augment the bodily tempera- 
ture, and to improve the nervous and sensorial 
powers. They are diffusible and temporary 
stimulants to the whole vital system. In some 
instances of debility, suitable wines appear to 
strengthen digestion ; but, perhaps, that saluta- 
ry consequence is rather due to their influence 
upon the sanguineous and nervous organs. The 
intimate connection between the health of the 
stomach and the circulation of the blood, ren- 
ders wine allowable where the vascular system 
is habitually weak ; and, probably, in such cases, 
wine prevents greater evils than those which it 
is known to produce. The most cordial Wine 
for old persons seems to be mild and old Sherry, 
when free from acidity. 

There is a poverty of blood which seems to 
arise from deficiency of the red colouring par- 
ticks, and for which medicated preparations of 



55 

iron and chalybeate waters are well known spe- 
cifics ; of all the remedies for pale-faced debili- 
ty at any age, chalybeates are the most effica- 
cious : it appears from the best chymical analy- 
sis, that the red colour of animal blood is deri- 
ved from iron, and the exhibition of it as a 
medicine is only the artificial supply of a con- 
stituent part of the body, where it is obviously 
wanting. 

Impaired Digestion is an extensive source of 
disorder ; for, whenever the food is not quickly 
acted upon by the living stomach, it becomes 
liable to fermentations. In old persons the 
food remains longer uncontrolled by the vital 
energies than in young persons, and is never so 
perfectly digested ; hence the food of old per- 
sons admits more readily of both the acetous 
and putrefactive fermentations, either of which 
happening, even in a small degree, occasions 
disorder of the stomach or intestines, and suffus- 
es the body with vitiated fluids. The acetous 
fermentation is most common, and it is especial- 
ly incident to those who eat raw vegetables,. 



56 

fruits, sweets, and fatty substances ; and every 
excess in diluent liquors is apt also to produce 
it. 

Experience and meditation persuade me, 
that alimentary acidities are the chief if not the 
sole cause of gout, of one kind of erysipelas, 
and of many herpetic diseases. When this ten- 
dency to acid has long prevailed, it is not easily 
corrected; and unless the most circumspect at- 
tention be constantly given to Diet, it will con- 
tinually recur. 

Acidity of the stomach is, moreover, a cause 
of obstruction to the flow of bile, and, under 
such disordered state, the whole body becomes 
tainted with crude humours. I have known 
many examples of acid stomachs linked with 
eruptions on the skin, and which were always 
sensibly aggravated within five minutes after 
taking acid food or acid drink. 

The rapid consequences which follow that 
state, called a surfeit, are further proofs of the 



57 

quick transition of disordered humours from 
the stomach into the rest of the body. 

Some of the dangerous and sudden disor- 
ders which arise from intemperance, may be 
averted by instant emetics ; but vomiting is an 
unsafe operation for old persons, and it is only 
warranted by pressing necessity. Purgatives 
should follow those emetics to expel the re- 
liques of corrupted aliment, and great precau- 
tion must be adopted afterwards respecting diet, 
and the free passage of the bowels. From neg- 
lect of these rules many disorders are allowed to 
accumulate, until at length they assume a for- 
midable aspect. 

Diseases, purely inflammatory, appear to be 
few and of rare occurrence ; whilst the most 
dangerous spontaneous inflammations are con- 
nected with established and vitiated conditions, 
which only require an exciting circumstance to 
bring them into activity. 

8 



58 

Diseases of the sanguineous system are the 
most frequent causes of death in all ages ; but 
they seldom occur to persons, whose alimentary 
organs and whose blood might be considered 
free from impurities. To these causes may be 
confidently ascribed erysipelas, gangrenous in- 
flammations, carbuncles, and many kinds of ap- 
oplexy, pneumonia, and gout, — diseases which, 
according to my apprehension, are closely allied 
to each other : obstructed bowels are likewise 
not un frequently the cause of an obstinate and 
distressing species of sciatica. 

Alkalis are the medicil remedies for occasion- 
al or habitual acidity in the stomach ; and twen- 
ty grains of carbonate of potash given as a cor- 
rector, in a wine-glass full of milk twice a day, 
will generally answer the temporary purpose. 
This medicine seems to act beyond its chymi- 
cal operation in the stomach, and . when used 
frequently it probabiy may pervade the whole 
body. I have often known it to speedily re- 
move painful conditions of the bladder and uri- 
nary passages, which were connected with sour- 



59 

ness of the stomach, although the disorders had 
continued for several months. The affections, 
called gravel, are generally of this kind. 

Alkalis, judiciously employed, possess both 
preventive and curative virtues for man^ disor- 
ders, especially for herpetic and long established 
eruptions of the skin ; and the rationale of their 
uses is better understood than those of most 
other medicines. 

In all cases of lowness and depression the vol- 
atile alkali is preferable, because of its cordial 
property. May not its utility, when taken for 
gangrenous erysipelas, be owing to its anti-acid 
effects ? To whatever extent hypothetical doc- 
trines may assign the powers of life, as capable 
of destroying all chymical effects within the hu- 
man body, experience affords practical evidence 
to the contrary ; and a scientific observer will 
soon perceive the great utility of administering 
Acid sand Alkalis as chymical remedies, making 
due allowances for the abatement of their action 
and want of precision in their doses, from the 



60 

variable and complex operations of living struc- 
tures. 

A popular hypothesis is now very prevalent, 
which attributes nearly all diseases to a disturbed 
state of the Liver ; and for which, mercurial 
drugs are lavished almost indiscriminately, as 
the professed remedies. The folly of expecting 
to repel this, or any other opinion which is fa- 
vourable to the natural indolence of mankind, 
is obvious, especially when it is at the same 
time upholden by the empirical interests of 
greedy individuals. 

The patrons of the universal bilious system, 
and the abbettors of its universal remedy, Mer- 
cury, may, perhaps awake from such reveries 
when they are warned of the variable and oppo- 
site ways in which the liver and its vessels may 
be deranged. The organ which makes the bile, 
may yield too much or too little ; or the bile 
may possess too much acrimony, or it may be 
deficient in the requisite degree of stimulus. 
The bile may be too rapidly discharged from 



61 

its reservoirs, or it may remain too long con- 
fined. The issues of the bile may be disturbed 
by disorders of the stomach, or errors of the 
bile may cause those disorders ; added to which, 
the liver and its functions may be healthful, 
while the intestines upon which the bile is des- 
tined to act as a stimulant, may be too irritable, 
or not sufficiently so. From this view it can- 
not be questioned whether bilious disorders 
ought to be considered as of one and the same 
kind, or whether the same remedy can be ration- 
ally employed for maladies so widely different. 

Such intricacies and complexities in the per- 
ilous art of Medicine ought to deter unqualified 
pretenders, and to demand greater deliberation 
and study from the regular Faculty. It is, how- 
ever, but justice to say, that the respectable and 
grave Referees of the profession are seldom 
turned aside by popular delusions. 

The various preparations of Mercury are, 
doubtless, of great value in the Medical Profes- 
sion ; but their excessive employment for eve- 



62 

ry supposed disorder of the liver cannot be de- 
fended, and the indiscriminate use of them as 
cathartics is often injurious. 

The profession of Medicine seems to be ad- 
vancing quickly into a rational and physical 
Science, and its progress must be accelerated 
by viewing the natural causes of diseases, and 
the rationale of remedies, according to the rules 
of Natural Pnilosophy. 

The free and unsophisticated practice of Eng- 
lish Medical Officers in the Army and Navy, 
during the late war, has done much to elevate 
the rank of their art, heretofore abused by mys- 
teries, formalities, and mercenary intrigues. 
Under the auspices of common sense, the treat- 
ment of two putrid diseases by acid antiseptics, 
which, perhaps, differ very little in their nature, 
— namely, Sea Scurvy, and pure Typhus Fe- 
ver, — has been most successful. The latter 
has been also alleviated in one of its direful 
symptoms by a mere reduction of bodily tempe- 
rature. The improvers of Medicine seem also 



63 • 

to be on the verge of determining with practi- 
cal certainty the respective physical causes of 
putrid and intermittent Fevers, and of fixing 
the curative Diet and Medicines for each. 

I know full well the danger of stepping be* 
yond the pace of the multitude, and of antici- 
pating improvements ; but having taught these 
doctrines satisfactorily for more than twenty 
years, I may now venture to claim and offer 
them to my Brethren. 

Both the mineral and vegetable acids are pow- 
erful correctors of putridity, but they do not 
contain any substantial nourishment ; as arti- 
cles of Diet or Medicine, their uses are of the 
antiseptic kind, and become needful where ex- 
cessive quantities of animal food are employed. 

The Aged are liable to untoward disorders of 
the urinary passages, and when any sudden ob- 
struction of this sort occurs, which does not 
arise from strictures or stone, it is commonly 
the sign of oppression of the brain; tending to 



* 64 

Apoplexy or Palsy, It is of leading impor- 
tance to discover whether the urinary impedi- 
ment has any connection with vascular plethora, 
or with alimentary depravities, because the life 
of the patient will hinge upon speedy, powerful, 
and proper administrations. The temporary 
and delusive relief derived from drawing off the 
water artificially, is of no avail to the patient's 
safety ; whilst diseases of the brain or the bow- 
els are sapping the chief organs of life. This 
ill-omened malady requires the aid of an experi- 
enced and resolute master of his art ; and under 
his auspices, the uplifted hand of death may be 
often turned aside, even at a very advanced age. 

It is a vulgar error to consider all dropsical 
diseases as the signs of debility, and the results 
of mere weakness. They are generally symp- 
tomatic of impaired constitutions ; but they of- 
ten proceed immediately from inflammatory 
causes, and from organic derangements. The 
local dropsy in the scrotum, called Hydrocele, 
is seldom of serious character, and ought not to 
create alarm. I pass over the diseases peculiar 



65 

to women, because it would be improper to in- 
troduce them in a work, which is addressed to 
general readers. 

In reverting to my first assertion, that Diseas- 
es and not the mere exhaustion of Age, are the 
ordinary causes of death in old persons, it may 
be beneficial to recapitulate those of most dan- 
gerous tendency, the* apparent origin of them, 
and the remedies which medical skill has disco- 
vered for their prevention or cure. 

Apoplexy, palsy, or pneumonia, arising deci- 
dedly from plethora, require vigorous bleedings, 
cathartics, and abstinence. The same diseases, 
when occasioned by intemperance, or injurious 
diet, require evacuanis and correctives. Ery- 
sipelas, carbuncle, or gangrenous inflammation, 
arising from surfeit in the stomach, or from 
foulness of the bowels, must be treated accord- 
ing to their ascertained causes. Gouty diseas- 
es, which are provoked and maintained by im- 
proper diet, can only be remedied by having 
recourse to a diet that is exact and appropriate* 

9 



66 

While the great excretory outlets of the body, 
the bowels and the urinary passages, with all 
their connections, must be constantly watched ; 
and when impeded, they must be timely assist- 
ed by art. 

From a wish to awaken the attention of my 
Brethren to these important cares and duties, 
I have ventured to solicit the confidence of the 
Elders of our race toward the Medical Profes- 
sion, with a full assurance that the Faculty now 
possess the power to protract life, and assuage 
suffering, under many of the circumstances 
which I have attempted to describe. 

To pass over the long list of Materia Medica 
in modern use, may be thought presumptuous ; 
but I prefer to risk the imputation, rather than 
waste my own and my reader's time in treating 
of the qualities of medicines, which are either al- 
together useless or uncertain in their operation. 
The art is already too much encumbered with 
frivolous prescriptions, and obscured by unwor- 
thy mysteries. Experience has satisfied me, that 



67 

many diseases may be prevented or removed b)5 
Temperance, and by the rational administra- 
tion of Medicines whose operations are under- 
stood, without much encroachment on the fair 
enjoyments of life. 

It is a wise maxim in Physic, that diseases 
which are long in their advancement, are gene- 
rally only to be remedied by long continued 
curative attentions. Common sense points out 
the fallacy of expecting to eradicate old estab- 
lished errors of the body, by any single or sud- 
den remedies. The warnings of dangerous dis- 
eases should never be forgotten ; and the diet, 
or medical regimen of such persons, should be 
undeviatingly suited to their disordered tenden- 
cies. 

To this general exposition of my individual 
experience and opinions, I shall add a few re- 
marks upon the moral propriety of Surgical ope- 
rations on Old persons. 



68 

The greater exertions of my life have been 
devoted to the collection of materials for a gene- 
ral review of Surgical Ethics ; a subject which 
appears to be at this time imperiously demanded, 
both for the welfare of the Public, and for the 
character of the profession of Surgery. 

Dangerous operations are rarely adviseable in 
advanced age ; because the living powers are 
then diminished, and old persons are seldom ex- 
empt from constitutional disorders. The disas- 
trous consequences of unsuccessful or impru- 
dent operations are most extensively injurious; 
and those desperate expedients are not justifia- 
ble upon the false and horrible plea, that the val- 
ue of life decreases as age advances. 

Whenever the immediate danger to life from 
a surgical operation exceeds the probability of 
recovery from its effects, the act is unjustifiable. 

When the consequences of a mortal disease 
are only to be averted by a dangerous operation, 
the enterprise may then be expedient. 



69 

When a contemplated operation involves the 
immediate danger of life, it should be carefully 
balanced with the pending danger from the dis- 
ease for which it is proposed ; and the operator 
should be governed by that prospect, which af- 
fords the best hope of procrastinating life. 

When a safe operation will alleviate the suffer- 
ings, or remove the inconvenience of a disease, 
it is preferable to one which promises perma- 
nent relief at the risk of life, 

When there is any striking probability that a 
patient may die under an operation, or of his 
being constitutionally unable to recover from its 
immediate effects, such operation is unwarrant- 
able. 

When other fatal diseases' are known to be 
lurking in the frame, such as consumption or 
tendency to apoplexy, it is right to avoid ail vi- 
olent operations. 



70 

The performance of surgical operations upon 
old persons, for the removal of harmless tumors 
or mere deformities, ought to be objected to. 

It is unsafe to perform operations upon old 
persons who are liable to erysipelas. 

The satisfaction which follows the observance 
of these rules, induces me to submit them to 
my Brethren of the profession ; but as the vital 
powers vary in' old persons, some exceptions 
will arise to any general rules which may be laid 
down for their treatment. 

I consider all the larger amputations, as those 
of the arms and legs, to be seldom adviseable 
for persons on the confines of Seventy, unless 
the occasion be sudden, and the patient of sound 
habit. 

The operation for the stone is, at ail times, 
dangerous ; and I think it better for men ad- 
vanced in life to bear the pains of that affliction, 
in preference to the risks and consequences of a 



71 



terrible expedient. I have at this time the care 
of three old Gentlemen, who have each had the 
stone for several years, and who are all thankful 
to me for dissuading them from the operation. 
One Gentleman, now in his Eighty-fifth year, 
has passed the last twelve months in comforta- 
ble ease from living quietly, temperately, and 
taking alkalis. 

Strangulated ruptures, in old debilitated per- 
sons, are generally reducible by the hand, the 
parts being more lax and yielding than in young 
persons, and the propensity to violent and dan- 
gerous inflammation is at that period abated. 

Hydrocele is most prudently treated by sim- 
ple tapping, particularly when the patient is fee- 
ble or in bad health ; because the attempt to 
cure that disease radically has often proved de- 
structive to old persons. 

It is revolting and disgraceful to hear of the 
numerous instances of fatal operations performed 
upon persons who are altogether uneiigible ; and 



72 

it may be remarked, that these mischievous ef- 
fects are not confined to the suffering parties, 
since evil reports spread widely, and are gene- 
rally unaccompanied by the paliative explana- 
tions which may belong to them. 

These rash proceedings are also injurious to 
Society, by deterring many persons from avail- 
ing themselves of Surgical skill, in cases where 
they might derive real benefit. 

However earnestly the afflicted may desire re- 
lief from loathsome, painful, or incurable dis- 
ease, even if they prefer the sacrifice of life to 
the endurance of protracted suffering, still the 
Surgeon should refuse to comply with their im- 
proper wishes, and not become a party to 
homicide. 

To prolong life under any circumstances, and 
to diminish the intensity and duration of bodily 
misery, is our bounden duty ; but we are not 
called upon to decide, whether it be better for 
a Patient to die under a violent struggle, or to 



73 

wait for the Almighty command, — such ques- 
tions are indeed above human authority. 

The same imperative objection is likewise 
applicable to the practice of giving poisonous 
doses of Opium, toward the close of painful and 
apparently fatal diseases, — a measure which 
ought to be equally reprobated, both from pro- 
fessional and moral considerations. 

Medical judgment is not infallible, and the 
event of recovery from the most hopeless state, 
is seldom impossible ; but to preclude even a 
forlorn chance, or to abridge the sufferer of one 
lingering moment, is far beyond the province of 
Medical Men. 

Desperate operators should be reminded, that 
it is not uncommon for persons to recover from 
diseases, which are generally supposed to be 
mortal ; — but I must reserve the further obser- 
vations upon that grave and momentous subject, 

10 



74 

until I am enabled to lay before the Public the 
particular evidences of my own practice, and 
my special deliberations upon Surgical Ethics. 



F I N I S. 



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